Category: Mental Illness

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To Solve the LGBTQ Youth Mental Health Crisis

— Our Research Must Be More Nuanced

Young people do not fall into neat categories of race, sexual orientation or gender identity. Research into LGBTQ mental health must take that into account

By Myeshia Price

Our youth are in a mental health crisis. Young people describe steadily increasing sadness, hopelessness and suicidal thoughts. These mental health challenges are greater for youth who hold marginalized identities that include sexual orientation, gender identity or race or ethnicity. Near-constant exposure to traumatizing media and news stories, such as when Black youth watch videos of people who look like them being killed or when transgender youth hear multiple politicians endorse and pass laws that deny their very existence, compounds these disparities.

But young people do not fall into neat categories of race, ethnicity, sexual orientation or gender identity. They reject antiquated norms and societal expectations, especially around gender and sexuality. Yet most research on people in this group, especially on LGBTQ youth, does not fully account for how they identify themselves. Approaching research as though sex is binary and gender is exact leads to incomplete data. This mistake keeps us from creating the best possible mental health policies and programs.

We need to collect robust data on specific populations of LGBTQ young people to better understand the unique risks they face, such as immigration concerns that Latinx youth may have that others may not. We can also better understand factors that uphold well-being, such as how family support affects Black trans and nonbinary youth.

LGBTQ young people of color, including those who identify in more nuanced ways than either gay or lesbian, are more likely to struggle with their mental health than their white LGBTQ counterparts. As researchers, if we can equip ourselves with this information about their unique needs and experiences, we can create intervention strategies that support the mental health of every LGBTQ young person rather than attempting to apply a “broad strokes” approach that assumes what works for one group must work for all.

As director of research science at the Trevor Project, the premier suicide prevention organization for LGBTQ youth, I lead projects that examine LGBTQ young people and their mental health in an intersectional way, accounting for the many facets of their identities and how society and culture influence how they value themselves. I and my colleagues conduct studies with groups of people who are geographically diverse and gender- and race-diverse to understand what drives mental health distress in a way that allows us to address specific needs in different populations. For advocates trying to improve mental health outcomes, this means they must consider stigma, how it turns into victimization, discrimination, and rejection and how it disproportionately affects people who hold multiple marginalized identities.

Our 2023 U.S. National Survey on the Mental Health of LGBTQ Young People, for example, found that LGBTQ youth with multiple marginalized identities reported greater suicide risk, compared with their peers who did not have more than one marginalized identity. To learn this, we asked young people demographic questions about race/ethnicity, sexual orientation and gender identity amid a battery of assessments. Based on survey questions about mental health and suicide risk, we’ve found that nearly one in five transgender or nonbinary young people (18 percent) attempted suicide in the past year, compared with nearly one in 10 cisgender young people whose sexual orientation was lesbian, gay, bisexual, queer, pansexual, asexual or questioning (8 percent). Among almost all groups of LGBTQ young people of color, the rates of those who said they had attempted suicide—22 percent of Indigenous youth, 18 percent of Middle Eastern/Northern African youth, 16 percent of Black youth, 17 percent of multiracial youth and 15 percent of Latinx youth—were higher than that of white LGBTQ youth (11 percent). And youth who identified as pansexual attempted suicide at a significantly higher rate than lesbian, gay, bisexual, queer, asexual and questioning youth.

The majority of research exploring LGBTQ young people’s mental health does not have the sample size to do subgroup analyses in this way or, in rare cases, opts to unnecessarily aggregate findings (such as when bisexual young people are not analyzed separately despite representing the majority of the LGBTQ population). Our recruitment goals are set on finding enough people in harder-to-reach groups, such as Black transgender and nonbinary young people, and not to simply have a high overall sample size. In doing so, we are able to analyze findings specific to each group and also ensure these findings reach a wide audience. However, just as other researchers, when we are unable to collect enough data for subgroups to appropriately power our analyses, we do not publish those findings.

What we hope is that people working in small community settings can design targeted prevention programs. For example, an organization that aims to improve well-being among Latinx LGBTQ young people can also provide appropriate support for immigration laws and policies because immigration issues feed into mental health. Or an organization focused on family and community support among Asian Americans and Pacific Islanders can also focus on LGBTQ young people. The data we have gathered can informed services at organizations such as Desi Rainbow Parents & Allies, National Black Justice Coalition (NBJC) and the Ali Forney Center, among others.

Researchers must be intentional about which aspects of sexual orientation and gender identity are most relevant to the questions they are trying to answer when designing their studies. They must use survey items closely matched to those categories. Researchers must find a balance between nuance and analytic utility—allowing young people to describe their own identities in addition to using categorical descriptors. This can look like including open-ended questions or longer lists of identity options. Taking steps like these are critical for collecting and analyzing data that reflect the multitudes of this diverse group of young people. I urge researchers to apply an intersectional lens to their work and public health officials and youth-serving organizations to tailor services and programming to meet the unique needs of all young people. That’s because a “one-size-fits-all” approach has never and will never work when the goal is to save lives.

IF YOU NEED HELP

If you or someone you know is struggling or having thoughts of suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 or use the online Lifeline Chat. LGBTQ+ Americans can reach out to the Trevor Project by texting START to 678-678 or calling 1-866-488-7386.

Complete Article ↪HERE↩!

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What Your Penis Says About Your Health

— Changes in penis performance or appearance may signal heart issues, diabetes and more

Your penis serves some big roles in your body. Of course, it houses a drainage system that allows your body to get rid of urine. It’s also a key player in the reproductive process and the act of making whoopie.

But did you know your penis also offers a window to your health? It turns out the performance or appearance of your penis can provide clues about what’s happening to you physically and mentally.

So, what secrets can the appendage reveal? Let’s look at six potential learning opportunities with urologist Ryan Berglund, MD.

1. Heart health

Erectile dysfunction, or the inability to get or maintain an erection, isn’t an unusual occurrence. Your penis may just decide to not cooperate at times for a multitude of reasons, many of which are no big deal.

But if you consistently have trouble getting or keeping your penis up, it might signal heart disease and blood flow issues.

A 2018 study linked erectile dysfunction (ED) to increased risk of heart attack, cardiac arrest and stroke. Dr. Berglund notes that almost two-thirds of people who’ve also had heart attacks also experience ED.

“Erectile dysfunction, particularly if you’re younger, should be regarded as a warning sign for heart disease,” he adds.

2. Diabetes

Difficulty getting or maintaining an erection also may signal the onset of diabetes, which can damage the nerves, blood vessels and muscle function that work in tandem to get your penis up.

Research shows that someone with diabetes is three times more likely to report instances of ED. In addition, ED often occurs 10 to 15 years earlier and is more severe in those with diabetes.

3. Mental health issues

The mind plays a very large role in the function of the penis, says Dr. Berglund. Psychological issues such as depression, anxiety and stress can lower sex drive and keep your penis from performing as it should.

Relationship troubles can hinder operations below the belt, too. Ditto for alcohol, smoking and drug use.

4. Scar tissue

Having intercourse with a less-than-firm erection can damage your penis and lead to the development of Peyronie’s disease, a disorder in which scar tissue within the penis causes a curvature.

The condition can lead to a noticeable bend in your penis. A curve greater than 30 degrees is considered severe. The loss of length or girth is possible, too.

ED can cause more flaccid erections that increase your risk of Peyronie’s disease. Talking to a healthcare provider about difficulties getting a hard erection and getting treatment could reduce your chance of sustaining the injury.

5. Infection

Lumps and bumps aren’t unusual on a penis. Blood vessels, pimples and pearly penile papules (small, pearl-like bumps) are just a few of the things you might notice on your penis, shares Dr. Berglund. In most cases, they’re nothing to worry about.

But how can you tell if there’s something more serious going on?

If the bump is painful or there’s an open or weeping sore, get it checked out ASAP. It may be a sexually transmitted infection such as herpes or syphilis. Less pain but lots of itchiness could signal genital warts or molluscum contagiosum (a viral skin infection).

6. Cancer

A discoloring of your penis along with painless lumps, crusty bumps or a rash could be a sign of penile cancer. Symptoms typically appear on the penis head or foreskin and should get checked by a medical professional.

The rate of penile cancer is relatively low in the United States, at 1 in 100,000. But it’s much more common in Africa, Asia and South America.

Final thoughts

It’s important to pay attention to what’s happening downstairs. Changes in the performance or appearance of your penis may be a sign of a larger health issue.

Is the topic comfortable to talk about? Maybe not. But if something with your penis feels or looks different, tell a healthcare provider. It’s a discussion that’s important for your overall health.

Complete Article ↪HERE↩!

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5 Facts All Men Should Know About Sexual Problems and Dysfunction

Male sexual dysfunction can include a wide variety of problems, ranging from low libido, erectile dysfunction (ED), premature ejaculation, and other issues. While many men know that these issues are common, they can be difficult to talk about. In fact, many men wait several months, or even years, before raising the issue with their primary care physician.

Thankfully, both normal and abnormal male sexual function are now better understood medically than ever before. Dr. Sharon Parish, Professor of Medicine in Clinical Psychiatry at Weill Cornell Medicine, maintains an active faculty practice specializing in sexual medicine. “I use an integrated, holistic approach, looking at the whole man,” explained Dr. Parish. “Often, men will first see a urologist and then are referred to me for a more detailed evaluation and discussion of their overall health.”

Here, Dr. Parish shares her insight as to the connection between male sexual, physical, and mental health.

Sexual problems may signal a cardiovascular or other medical issues

“Any man that experiences a change in libido, erection, or ejaculation should bring this up to their primary care physician,” said Dr. Parish. Any issue that lasts for several months may indicate a more serious medical issue that should be addressed:

  • Early ejaculation can develop because of medication, nerve damage, or other direct urinary conditions
  • A change in libido or erection may be the first sign of diabetes
  • Problems with libido or erection may be related to a hormonal imbalance
  • Problems with erection may be a sign of a cardiovascular issue or prostate cancer

There is a strong link between sexual function and mental health

Mental health issues — including depression, anxiety, and other psychiatric illnesses — can lead to many different types of sexual disorders. “It’s clear that there is a strong connection between ED and depression,” asserted Dr. Parish. “Women, on the other hand, who experience depression are more likely to see a decrease in libido. It’s very important to diagnose the psychiatric illness first to improve sexual function.”

Sexual function is often improved by addressing, managing, and alleviating anxiety and depression. “There are many helpful therapies,” Dr. Parish explained, “including mindfulness, cognitive behavioral therapy, and relaxation techniques to help one be more present in the experience and enjoy it more fully.”

Medications for mental illness may cause sexual function changes, to varying degrees

“There is a wide misconception that the medications for mental illness cause sexual problems, but the data is clear that sexual function is more likely to improve when the mental illness is treated,” said Dr. Parish. “It’s not a good idea to avoid the medication because of the potential side effects.”

Fifty to 70 percent of men do not experience any sexual side effects from medications, and men taking medications for serious psychiatric disorders are more likely to experience a sexual side effect.

“If you do experience sexual problems as a result of a medication,” Dr. Parish explained, “work with your doctor to manage the side effects. Several drugs are known to produce lesser side effects.”

Again, Dr. Parish emphasized the importance of mental health for sexual health. “The key,” she stated, “is to treat the mental disorder and then the sexual disorder. It’s best to get the condition treated and work with the doctor to manage the side effects.”

With age, some changes in sexual function are normal

Some changes in sexual drive, performance, and function are normal parts of aging. “As men get older,” said Dr. Parish, “they may need more time for foreplay or direct stimulation. If this isn’t enough to improve normal age-related changes in sexual function, sex therapy can be very beneficial.”

However, if the changes are dramatic or difficult to work through, Dr. Parish suggested talking to a primary care physician. “Your doctor can help you differentiate normal changes from more problematic issues, including medical issues,” she said. “Don’t assume it’s a normal change that comes from getting older.”

Improving overall health can improve sexual performance

Dr. Parish ascribes to the “biopsychosocial model” for overall and sexual health. “There is so much interconnectivity when it comes to our health,” she explained. “It’s important to take a holistic view.”

Indeed, cardiovascular, neurological, hormonal, and psychological systems all interact together for sexual performance. A healthy lifestyle can significantly help improve sexual function — improving diet, achieving and maintaining a healthy weight, and exercising regularly all help promote greater overall health and, therefore, greater sexual health.

Complete Article ↪HERE↩!

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LGBTQ+ mental health

— From anxiety to abuse, how to better protect yourself and seek support

by Jamie Windust

Open dialogue around mental health is becoming more consistent every single day. Whether it be in the workplace or at home, as a society we are learning to talk more about what’s going on in our minds.

But what if you’re LGBTQ+? Often we face specific challenges that our non-queer counterparts don’t face. Anxieties around coming out or transitioning can make life hard in ways that we can’t always openly share.

To help out, GAY TIMES sat down with LGBTQ+ psychiatrist Dr David McLaughlan to ask some of the most common questions LGBTQ+ people have surrounding their mental health. See this as a resource to save and keep handy whenever you feel like there isn’t a space to have your questions answered.

Is there anything LGBTQ+ people should avoid doing if they’re struggling with their mental health?

Be wary of ‘quick fixes’ or self medicating with drugs and alcohol. It almost always makes things worse. I’d also avoid bottling things up. If something doesn’t seem right, don’t just leave it and hope it gets better by itself. Sometimes it can feel frightening asking for help, but almost no one regrets it once they’ve done it. It’s a bit like coming out – liberating and a relief.

Who should LGBTQ+ people try and speak to if they’re worried about their mental health?

You should speak to anyone you feel comfortable with. The most important thing is just speaking to someone. It could be your best friend, your sibling, a neighbour or even a stranger. Sometimes just hearing yourself acknowledge your own mental health out loud can be the first step. I’ve had patients who told me that they began by journaling first. This helped them reflect upon their thoughts and feelings by themselves before they felt confident enough to talk about it out loud with another person.

What do you see most in LGBTQ+ people who come and speak to you about their mental health?

Lots of my LGBTQ+ patients have experienced trauma or adverse life events. Sometimes there is a significant event which triggered an initial deterioration in their mental health, such as an assault. However, there often is an insidious accumulation of trauma or adverse life effects which accumulate over time.

These are things like bullying, discrimination or micro-aggressions. It can happen anywhere; at home with family, in the workplace or out in public when using public transport for example. On a cellular level, trauma or an adverse life event exposes our neurons (the cells in the brain responsible for receiving sensory input from the external world) to the stress hormone cortisol, which is cytotoxic. This means that stress literally kills brain cells… In studies, scans have shown that people exposed to trauma or repeated adverse life events have structural differences in their brains.

In terms of diagnosis, I see a lot of anxiety disorders within the LGBTQ+ community. Anxiety disorders are a diverse range of conditions which include Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), Panic Attacks as well as Generalised Anxiety Disorders and specific phobias. For example, Agoraphobia.

I also see lots of substance misuse. There are specific trends and patterns of substance misuse within LGBTQ+ subcultures. For example, the use of Crystal Meth within cis-gay men engaging in chemsex compared to an older cis-gay woman may be more vulnerable to alcohol abuse, often characterised by drinking alone at home.

One of the things I always try to communicate and recognise is that we are a really diverse community, with diverse biological, social and psychological experiences and accordingly, our needs are really diverse which makes it tricky sometimes to understand and support everyone. However, the key is to continuously listen and actively seek opportunities to learn.

What are your top tips for handling anxiety around coming out?

It’s okay to feel anxious about coming out. It can be a really big deal for some people and it’s not always easy. Each of us has a different set of circumstances that we have to navigate when we come out. Our families, friends, homelife, cultural background, careers and environment all play a big part in the experience of coming out.

However, sometimes when we are really anxious we imagine that things will be much worse than they really will. These negative predictions about the future can be affected by a cognitive distortion called ‘catastrophisation’. In this situation, our mind goes into ‘what if’ mode, automatically imagining the worst possible thing that could happen.

It might be worth gently challenging some of these predictions. Ask yourself, ‘Is it possible that I could be catastrophising?’, ‘Are there other possible outcomes which aren’t as bad?’.

The most important thing is doing it when you feel safe and ready.

What should LGBTQ+ people do if they’re struggling with alcohol or drug dependency?

LGBTQ+ people are disproportionately affected by drug and alcohol misuse as well as mental health difficulties. Despite this, they’re less likely to ask for help, with 14% reporting a fear of discrimination as the barrier to seeking mainstream support. 

According to Stonewall’s LGBT Health In Britain Report (2018) and the UK Household Longitudinal Study (Becares. L 2020)

  • 1 in 6 LGBTQ+ people said they drank alcohol almost every day over the last year
  • 1 in 5 Gay, Bisexual or Trans men drank alcohol almost everyday over the last year compared to 13% of LGBT women and 11% of non-binary people
  • 52% of LGBT people experienced depression in the last year
  • LGBT older women are almost twice as likely as heterosexual women to have harmful drinking habits. 

This was, in part, why I co-founded Jitai – an app which helps people reduce or cut down drinking. I felt passionately that everyone who wants to reduce or quit drinking, should be able to access support, regardless of their sexuality, gender or financial status.

The app will offer a range of personalised tools and techniques such as mindfulness, breathing exercises and its own unique motivation board to help beat temptation. In our first pilot study, 90% of our users told us that we had helped them achieve their goal of cutting down or quitting drinking. 

We’ve had some really incredible feedback from users which was amazing and made me realise that we are really helping people. 

What’s the best way to deal with social anxiety as an LGBTQ+ person?

A lot of LGBTQ+ people experience social anxiety. We grew up in a world where being ourselves was potentially something dangerous or put us at risk of bullying or social exclusion. 

One of the exercises that I do with my patients at The Prior Hospital in Roehampton is an attention training exercise. I ask my patients to practise shifting the focus of attention away from themselves and onto the world around them. 

Stage 1 is to recognise when you are experiencing self-conscious thoughts, feelings or bodily sensations. For example, thoughts such as ‘everyone is staring at me, I sound so stupid’.

Stage 2 is about shifting the focus of your attending away from our internal world and fixing it onto the world around us. Start by taking a few deep breaths, then looking around you. What can you see? Do you notice anything interesting about the shapes, colours or textures? How would you describe an object you’re looking at to someone who had never seen it before? Can you take a curious, non-judgemental approach and work through each of your five senses to draw the focus of your attention away from yourself and onto the world around you?

Your mind is like a muscle. This exercise can be tricky at first, but gets easier with practice.

Complete Article ↪HERE↩!

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Our mental health is seriously impacting our sex lives

It turns out sexual problems are even more common than mental health problems – and the two can exacerbate one another.

By Beth Ashley

As I grew out of playful, teenage sexual relationships that had little drama and joined the world of adult dating – where sex becomes a little more emotional and certainly more complicated – my mum had one piece of advice that she promised was the gospel truth. ​“The genitals are the brain,” she said solemnly. Well, actually, she said, ​“dicks are brains and brains are dicks,” but I’m paraphrasing to be gender inclusive. The first time she said this, I thought she was just uttering nonsense. But after I hit my first real struggle with mental health and sex, it clicked into place.

While we’re unlikely to realise it in the moment, poor mental health has a profound impact on our sex lives. Throughout most of my late teens, I struggled to stay present in my body during sex and even developed mild vaginismus (a psychosexual condition where the vagina involuntary contracts, usually due to anxiety). ​“She just acts up sometimes,” I’d awkwardly joke to one night stands. But I was overlooking the real source. I’d just been through a hard year packed with trauma and leaving it unresolved had left my vagina – and my sexual self in general – dealing with the consquences. Naturally, once I began to work through the traumas that led me there, sex slowly but surely became easier again. It turns out that, as always, mum was right. Genitals truly are the brain.

“While we’ve got a lot better at talking about mental health and normalising those conversations, we’ve still got a long way to go with sex”
DR LAURA VOWELLS

Thankfully, we don’t all have to rely on my mum’s findings to decode the link between the brain and the down-belows. Relationship and sex therapy app Blueheart recently found that 74 per cent of adults struggling with their sex lives say it’s due to stress or a mental health strain, and they’ve done some digging into why that is.

Dr Laura Vowells, one of the founding therapists working at Blueheart, says mental health and sexual desire are ​“intrinsincally linked”, impacting one another at all times. ​“While we’ve got a lot better at talking about mental health and normalising those conversations, we’ve still got a long way to go with sex,” she says. ​“It’s still weird to talk openly about sex problems with friends or family, and there’s still this weird idea that we’re not supposed to be enjoying sex and therefore not supposed to complain about it.”

Adding to the problem, a lot of mainstream mental health services don’t ask about the patient’s sex life when they reach out for support. If a medical professional doesn’t view sexual problems as something worth bringing up, why would a patient? ​“But they both affect one another. What a lot of people don’t know is that sexual problems are actually more common than mental health problems – we just don’t talk about them,” Vowells explains.

Similar to my situation, 23-year-old Katie struggles with acute, mild vaginismus whenever she’s struggling with her generalised anxiety disorder. ​“It’s well-managed for the most part, but we all have troughs and my vagina is always the first thing to go. It took me a long time to learn and properly notice that though,” she says. Katie used to ​“get really upset” when sex was ​“off the cards” and she couldn’t fathom why. ​“But now it’s one of those things where I just call it like I see it. I’m like, ​‘Oh yeah, I don’t have sex when I’m sad. When I’m happy, I’ll have sex again. That’s cool.’”

The Blueheart survery also found that 31 per cent of respondents were suffering from symptoms associated with more serious sexual dysfunction. This includes arousal and orgasm issues, which range from taking an extended amount of time to become sexually aroused or climax, or experiencing unsatisfying orgasms, to being unable to achieve sexual arousal and climax at all. For those facing more serious sex-related issues, seven out of 10 believed poor mental health or increased stress levels were the cause.

In the UK, more than 51 per cent of women and 42 per cent of men report experiencing sexual dysfunction. And considering that accessing proper sex education is a postcode lottery, the NHS has cut services for sexual dysfunction and didn’t really ever have funding for mental health services in the first place, having these conversations with our loved ones and in public (if you’re comfortable to) is now more important than ever.

When moods and libidos drop, a lot of partners of people struggling with their sex-brains can also suffer with their own insecurities and doubts. Luckily, Vowells has buckets of advice for couples going through this. She tells THE FACE that ​“it’s really important to talk to your partner about how we feel as it’s happening. As humans, we feel very self conscious around sex. And when a partner withdraws from us sexually, we start to wonder if they’re not interested anymore, or maybe I’m not as attractive anymore. We naturally start to feel rejected and that makes the relationship problems worse.”

So, if you’re going through sexual withdrawal as a result of mental health issues, your partner might need some reassurance. ​“Part of why a lot of people feel depressed around sex is because they’re worried about letting their partner down,” Vowells explains. Avoiding these conversations will make everyone involved feel worse.

And for the partner on the receiving end? ​“Try not to take sex withdrawal from your partner personally,” says Vowells. ​“See how you can help and support them in order for you to get what your partner needs. Don’t do that so you can have sex, genuinely do it for them. Your primary goal should be supporting them to manage their mental health.”

Once you get in touch with your mind and how it impacts sex, you’ll eventually learn to expect sexual changes when mental health challenges arise and figure out how tackle repeitive sexual problems head-on – especially if you talk to a sexologist or therapist

This is something 26-year-old Charlotte* does with her boyfriend. ​“I withdraw from sex when I’m stressed but my boyfriend wants more sex when he’s stressed. For a while we kept arguing and felt lost, but after three years together, and a lot of trial and error, we expect our sex to be down whenever our mental health is down, and we know we need specific and different things for it,” she says. ​“You eventually get to that point if you talk enough about it.”

For the time being, Vowells offers this advice: if you’re feeling more anxious, stressed or depressed, ask yourself questions about sex to pinpoint, apprehend (and not overthink) sexual changes. ​“Ask yourself, ​‘OK, am I having sex as much as I was before? Am I thinking about sex the same way? Am I enjoying my sex?’” The answers to these questions can tell us a lot about whether our muddied brains have infiltrated our sex.

It’s easy to feel beaten down when sex problems emerge. We grow up with this idea that sex is easy, as simple as falling asleep or taking a dump. The reality, though, is that sex is complex and we all have specific, individual needs. And when our heads are in the shed, our sexual needs and behaviours are likely to fall away from the familiar. At least now we know our brains and genitals act as one, we can decipher the real meaning behind our sexual problems a little easier and dismantle both stigmas together. Thanks, mum.

Complete Article ↪HERE↩!

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5 common conditions that can lower sex drive

By Charlie Williams

The science is clear: Sex can bring some incredible benefits for your health. Study after study has shown that having sex regularly can improve longevity, reduce the risk of heart disease, stroke, and certain types of cancers, bolster the immune system, improve sleep, enhance mental health, reduce depression symptoms, and improve overall quality of life.

Common conditions, like cancer, diabetes, heart disease, etc, not only affect patients’ physical health, but also their sexual health.

Despite this, sex remains a taboo topic in American culture. We don’t even know how to address it to children in schools. For instance, in the late 1990s, the US government adopted the abstinence-only-until-marriage (AOUM) approach to adolescent sexual and reproductive health. Public schools in 49 of 50 states accepted federal funding from this program. As a result, public school sex education focused on raising awareness of the risks of sex, like sexually transmitted infections and youth pregnancy, rather than balancing the risks with the scientifically supported benefits. What’s more, rigorous research showed that AOUM failed to achieve its goal of delaying sexual initiation, reducing sexual risk behaviors, or improving reproductive health outcomes.

The history of American inhibitions about sex is too complex to detail here. Suffice to say that because of these longstanding cultural mores, modern public discourse about sexuality is often described in a negative light, focusing on the risks and dangers of sex. Meanwhile, discussion about the physiological and psychosocial health benefits of sex is commonly ignored, according to a white paper from Planned Parenthood.

This discussion might be missing in physician’s exam rooms, too. Six in 10 American adults have chronic disease, but it’s likely that they aren’t receiving sufficient education to help them cope with the effects that their conditions can have on their sexual health, and how those effects can change their quality of life. The problem becomes more challenging when considering that cultural mores prevent patients—and physicians, too—from broaching the subject simply because it’s uncomfortable to talk about.

So, next time you suspect a patient has one of these conditions, consider spurning the taboos and help them understand its implications for their sexual health and overall quality of life.

Cardiovascular disease

According to the American Heart Association, decreased sexual activity and function are common in patients with cardiovascular disease (CVD), but not for the reasons you might expect. Patients with CVD often endure psychological distress because of their conditions, which is correlated with negative downstream effects on sexual function. In patients with coronary artery disease, heart failure, congenital heart defects, recent heart attacks, coronary artery bypass grafting, implantable cardioverter defibrillators, and cardiac transplantation, sexual activity frequency and satisfaction often decline because of the anxiety that sexual activity will worsen the underlying cardiac condition or cause death. That anxiety can lead to depression, an important contributor to erectile dysfunction (ED) and decreased libido.

While some patients with severe CVD may be putting themselves at increased risk for complications by having sex, doctors can clear many patients for sex after a simple physical exam or exercise test. For those with depression, anxiety, or decreased libido, physicians can recommend patient and partner counseling, refer to psychiatrists, or prescribe medication.

Diabetes

Long-term poor blood sugar control can damage nerves and blood vessels, inhibiting feeling and the blood flow that is necessary to maintain an erection, according to the Mayo Clinic. As such, some male patients with diabetes are likely to experience ED while managing their condition. Other conditions that are common in men with diabetes can commonly cause ED, like high blood pressure, heart disease, and depression.

Women with diabetes are also likely to experience decreases in sexual function, including reduced libido, decreased vaginal lubrication, and reduced or absent sexual response, including the ability to stay aroused, achieve an orgasm, or maintain feeling in the genital area.

The good news is that diabetes can be a preventable condition, and sometimes reversible in those who have already developed it. Many of the factors that cause symptoms that reduce sexual function and desire in patients with diabetes can also be reversed. Plus, many of the factors, like improving blood sugar levels, have the added benefit of helping patients feel better overall and improving their quality of life.

Obesity

While the health hazards of obesity have been thoroughly studied and are well known to most patients, its effects on sexual health are not frequently discussed. For instance, obesity in men reduces testosterone levels and increases the likelihood that men will experience ED. Moreover, obesity can have negative impacts on fertility—it has been linked to low sperm counts and reduced sperm motility, both of which have been shown to make men less fertile.

Women who are obese experience similar reductions in sexual health. Researchers have shown that obese women have lower sexual function scores, and that weight reduction seems to improve sexual function in young obese women. Moreover, obese women are 4 times more likely to experience an unplanned pregnancy than normal weight women, despite them reporting lower rates of sexual activity.

As with diabetes, the good news is that obesity is a preventable condition. And just like diabetes, reducing obesity will not only bring beneficial effects to sexual health, but to overall health as well.

Cancer

Many types of cancer can have detrimental effects on sex to varying degrees. “Some surgeries and treatments might have very little effect on a person’s sexuality, sexual desire, and sexual function,” according to the American Cancer Society. “Others can affect how a certain body part works, change hormone levels, or damage nerve function that can cause changes in a person’s sexual function.”

Doctors, caregivers, and partners can help patients with cancer confront issues of sexual health by maintaining discretion, helping to talk through emotional issues, helping address problems with self-esteem, and tracking side effects. 

On the upside, sexuality and intimacy have been shown to help patients with cancer bear the burden of their disease by helping them cope with feelings of distress.

Mental health disorders

Healthy and intimate sexual relationships are a key component of mental well-being. But, common mental health problems like anxiety, depression, personality disorder, seasonal affective disorder, and bipolar disorder can all have detrimental effects on sexual health.

Notably, a markedly decreased sex drive is a common indicator of major depressive disorder, according to Jennifer L. Payne, MD, director of the Women’s Mood Disorders Center, Johns Hopkins Hospital, Baltimore, MD.

“Change in sex drive is a key symptom we look at when deciding if someone fits the diagnosis for major depressive episodes,” Dr. Payne wrote. “A primary symptom of depression is the inability to enjoy things you normally enjoy, like sex.”

But mental health disorders don’t exclusively cause a reduction in sex drive and performance. Some individuals, including those with compulsive sexual behavior, can become consumed by sexual thoughts and an out-of-control sex drive. Like most addictions, when sex addiction and compulsive sexual behavior is left untreated, it can damage self-esteem, relationships, careers, and health. 

Time to have ‘the talk’

Both the patient and physician may feel uncomfortable in the exam room broaching the subject of sex. But, consider that studies have shown that most patients with CVD believe they haven’t been appropriately educated about their conditions’ effects on sexual health and desire more information on how to resume their normal sexual activity. Other patients with common conditions most likely feel the same way. 

Having an open discussion or referring patients to counseling can go a long way toward improving sexual health, which in turn can provide both physical and mental health benefits.

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Meet the BDSM therapists treating clients with restraints, mummification and impact play

By Gillian Fisher

When we say BDSM, you probably think of chains, whips, and all sorts of sexy stuff.

But there’s far more to it.

BDSM has long been recognised as an erotic practice, with more people than ever introducing aspects of bondage, domination, sadism and masochism into their sexual pursuits.

A combination of changing sexual attitudes and greater representation in mainstream media has sparked a new curiosity surrounding the pleasures of submission.

While BDSM has typically been categorised as a sexual preference, some professional dominants have decided to apply the key principles of control and abandon to therapeutic practice. According to these specialists, their specific brand of holistic BDSM has helped clients with a range of emotional issues from trauma to anxiety.

London-based Lorelei set up her own business as the Divine Theratrix in September 2018 after two years working as a therapeutic counsellor. Marketing herself as a ‘loving female authority’, Lorelei uses BDSM components such as restraint and impact play (rhythmic hitting) to enable her clients to open up.

Lorelei, 33, tells Metro.co.uk: ‘The first time I introduced BDSM to a therapy session, the client progressed more in two hours than they usually would in two months of traditional counselling. Having your physical presence is so powerful.’

Lorelei began to explore BDSM therapy after becoming frustrated by the rigid detachment she has to retain during traditional counselling sessions.

‘I was struggling with the barrier,’ she explains. ‘I thought “Christ if I could actually have contact with clients, I know it would make a difference to them”.’

The former lawyer became involved with BDSM while exploring her own sexuality at sex parties and was particularly drawn to the role of a dominant. Lorelei looks entirely unimposing, with a youthful, elfin face and a petite frame clothed in black trousers and a lacy black top. Despite her delicate appearance and obvious warmth, Lorelei has a certain air of command; a no-nonsense kind of confidence that one can imagine her using to great effect in her work.

Having gained her diploma in therapeutic counselling, Lorelei was struck by the similarities between BDSM and conventional therapy. A BDSM session with her is broken down into three main parts, which are holding (establishing the power dynamic and trust), opening and then putting back together again, which could easily describe a formalised counselling session.

But unlike standard psychoanalysis where everything is achieved through talking, Lorelei will apply physical and occasionally painful actions such as nipple tweaking or flogging to facilitate the different stages. This is always a detailed conversation about the client’s limits and session goals.

She also holds her £200 per hour sessions in a rented dungeon while garbed in classic fetish wear, which Lorelei explains reinforces the power balance and takes clients outside of their daily reality.

Lorelei tells us: ‘I deal with a lot of clients who have a lot of early trauma, which is incredibly difficult to shift because it’s in your primal brain, which predates any cognitive thought processes.

‘I know from personal experience that these feelings can be very overwhelming and they need to come out. In this setup, clients know that because I am completely in control, they can totally let go and I will be there to make sure they feel safe and feel held.

‘Just because I’m a dominant doesn’t mean I can’t be nurturing.’

Because of its reliance upon specific power roles, anticipation and the relinquishing of control, BDSM is an inherently psychological practice. But how does a BDSM healer make emotional catharsis and not sexual gratification the primary goal of a session?

New York based Aleta Cai tells us: ‘Making sure that client understand what they want to achieve through a session is key. I make it very clear that healing and self-actualisation are the primary objectives of my sessions.’

Aleta practices what she describes as Sacred BDSM which combines new age modalities such as reiki and clairvoyance with traditional BDSM devices, including sensory deprivation and restraint. A self-described empath, Aleta explained that the BDSM template allows clients to access a deeper level of surrender.

‘I feel that in the West, there is a focus on psychoanalysis and probing the rational mind, which can lead to people getting stuck in their own narratives,’ Aleta says. ‘Things may be alerted to the rational mind that the body needs to process, and BDSM can facilitate that processing.’

Born in China, Aleta moved to Los Angeles during infancy and has retained her tinkling LA inflection. However, the 29-year-old speaks in a slow, measured manner which demands full attention. After completing her degree in Psychology at NYU, Aleta worked as a professional dominatrix at a well-known BDSM dungeon for two years.

Her transition towards Sacred BDSM began three years ago. The turning point came during a standard mummification session (this process involves being wrapped up like its Egyptian cadaver’s namesake) where Aleta introduced crystals and healing energy devices to the process.

Aleta said: ‘I was amazed, in just 20 minutes I felt the client’s different energies being unblocked and the immense sense of release he experienced. That’s what began my journey towards introducing certain elements into my own healing work.’

The reiki master also runs what she calls a ‘vanilla’ healing practice alongside her multiple artistic projects. Spirituality informs both practitioners’ work, with Lorelei being inspired largely by branches of matriarchal mysticism and paganism while Aleta is particularly influenced by Eastern medicine and esoteric theologies.

Aleta says: ‘My intention is to maximise their healing through BDSM so for instance if I felt someone’s root chakra is very heavy, I would cane them repetitively until I saw a somatic relief in that chakra. If I mummify someone, I will take them into hypnosis which will allow them a deeper layer of catharsis that is not just the physicality of being wrapped up.’

The concept of accessing a kind of heightened consciousness through BDSM makes sense scientifically as pain triggers adrenaline and endorphins which can lead to feelings of euphoria. For this to be experienced in a therapeutic and emotionally releasing manner is mostly dependent upon how the activity is framed.

Seani Love said: ‘A lot of BDSM does involve some level of therapy anyway, because sexuality is humanity’s inherent driving force. But when you outline the BDSM experience as an emotionally healing practice, it involves all aspects of the person making the release not only psychological, but also emotional, physical and spiritual.’

The Australian native applies a variety of disciplines to his BDSM work, including Pagan ritual and Qigong, in what he describes as a ‘hodgepodge of healing practices’.

The former software engineer began working part-time as a Shamanic BDSM practitioner eight years ago, finally going full time in 2013. Seani now prefers the title of sex worker and has won awards for his travail, which earn him £390 for a three hour booking. However, the 49-year-old still runs sessions and workshops specializing in Conscious Kink and BDSM therapy. It was Seani who personally mentored Lorelei while she was deciding what path she would take.

At the start of our meeting Seani seems slightly nervous; softly spoken and prone to fidgeting. As the interview gets further underway he seems to relax a little, obviously passionate about the remedial aspects of his work. When asked about his greatest achievement during his BDSM therapy career, Seani describes an intense experience with a 65-year-old client who had been rejected by his mother after being dropped on his head.

‘I called in a female assistant so he could experience some maternal love in his body during the session,’ Seani tells us. ‘We retraced some particular steps, used some impact play to get him out of his head and got him back to that pre-verbal stage, then invited the assistant to hold and nurture him. It was so powerful; he finally found peace with his mother from the ritual we created.’

Seani also has a background in gestalt therapy and a level 3 diploma in counselling, but has found his particular therapeutic niche within the erotic and BDSM sphere. While he has helped many people through applied BDSM, he is quick to state that it isn’t the right path for everyone.

‘I think it’s important for me to say that I wouldn’t prescribe shamanic BDSM as a healing path for all people,’ he notes. ‘I would never directly recommend it, but if people are drawn to it, it’s available.’

At first glance, BDSM therapy seems contradictory. Alleviating emotional distress with physical pain seems illogical, even detrimental. But when done skilfully, this practice enables the expression of raw emotion, without rationalisation or any holding back from the client.

People have turned to primal scream sessions, isolation tanks and rebirthing therapy in pursuit of emotional balance and found such practices effective. With mental health conditions making up 28% of the NHS’s total burden, perhaps for some select people, an overtly physical approach could provide the release that is so desperately needed.

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How mental health issues are preventing couples from having sex

By

Unconsummated relationships, where couples don’t have sex due to difficulties, trauma or sexual dysfunction are not often spoken about.

Usually, the couple feel embarrassed to discuss their sexual difficulties – but they are not alone.

According to an AXA PPP survey, a third of Brits are fearful of getting naked, largely due to body image and self esteem issues.

But nerves around body image aren’t the only reason couples aren’t able to consummate their relationships.

Why aren’t couples having sex?

Sarah-Jane Otoo, psychosexual therapist at Priory Wellbeing Centre Birmingham, tells Metro.co.uk: ‘Unconsummated relationships including marriages are largely unspoken about and the reasons behind them are often complex.

‘Some of the most common reasons are from a psychological viewpoint and include a general lack of education around sexual intercourse, fear, anxiety, shame and/or past trauma.

‘In addition, sexual dysfunction like erectile dysfunction, premature ejaculation, performance anxiety in males and vaginismus in females has been reported in several studies as well as vulvodynia, an often unbearable pain when the genitals are touched’.

Relationships expert Ben Edwards expands on this, telling us: ‘Post-traumatic stress and the psychological damage from past sexual abuse, low self-esteem or unhealthy relationships can be very hard to overcome.’

We must not overlook the impact of sexual trauma and mental health issues.

Aubrey Good has bipolar disorder, which dramatically affects her sex drive.

‘I can sometimes see a decreased or lack of libido, due to my bipolar disorder,’ Aubrey tells Metro.co.uk. ‘During periods of depression, my self-esteem tends to plummet.

‘Mixed with decreased energy and an increase in apathy, my body rejects physical intimacy in favour of seeking emotional nourishment.

‘I suffer from frequent bouts of hypersexuality. I am unable to receive any satisfaction from sexual intimacy and am often in pain or discomfort because of this.’

Aubrey takes medication, but like many taking pills for their mental wellbeing, has found that this has an effect on her sex drive, too.

‘A medication increase has caused me to have loss of libido,’ she explains. ‘Gaining weight from medication has contributed to my struggles.’

For Aubrey, the key is being able to communicate with a partner who understands her struggles.

‘Libido changes are a chronic challenge,’ says Aubrey. ‘Maintaining open dialogue with my partner has helped to ease the anxiety.

‘Sex is an emotional act as well as physical; we discuss the struggles and have seen progress. Therapy has also been a relief. Our strong emotional connection has allowed us to make it through.’

For Emma (name has been changed), anorexia has brought on issues with intimacy.

‘My body image is awful,’ she tells us. ‘I am embarrassed and ashamed of the way I look and it takes me an extremely long time to feel comfortable with men.

‘It’s been the cause of many of relationships endings. Ironically, my eating disorder started at age 19 in large part due to a guy telling me I was overweight so it’s something I’ve never shaken off.

‘I had a lot of negative thoughts about my body during sex so wasn’t able to enjoy the moment, don’t enjoy being touched or looked at, and have difficulty relaxing.

‘If I had eaten too much, was having a bad day or  stressed, then the eating disorder symptoms would creep in and I wouldn’t be able to have sex.

‘Counselling has helped me somewhat and taking things very slowly so I build up trust.’

Kate Moyle, a sexual and relationship psychotherapist, explains that anxiety is a common factor for a lack of sex in a relationship.

‘Every couple is unique and will have their own reasons and experiences for not consummating their relationship,’ she tells us. ‘These situations are often linked to some form of anxiety around sex which can in some instances impact sexual functioning. Some people may struggle with intimacy.’

For Sarah, 35, who has borderline personality disorder, that anxiety comes from a lack of self-confidence as well as a lingering shame around sex.

‘My husband and I have been together for 16 years, married for 12,’ Sarah tells us. ‘I always felt very prudish talking about sex due to my family background, before, during or after.

‘I was told not to have sex before marriage, so it always felt dirty and wrong.

‘My mental health issues mean my self confidence is rock bottom. I’m at my heaviest weight and although occasionally I enjoy sex, I mainly do it so he doesn’t leave me.

‘We had marriage counselling which helped for a while, but nothing really helps.

‘My husband manages to stay with me. He says he misses not having more sex but he says it would never be a cause to leave me. I wish I could be more confident.’

So what can you do if you need help with psychosexual issues?

The main remedies are psychosexual therapy, counselling and working on communication, touch and intimacy.

Sarah Jane Otoo says: ‘It is important to remember that not one person in the relationship has the “problem”; you are both impacted. Psychosexual relationship therapy can be beneficial to help support couples that are experiencing problems with sex.

‘People may choose to enter therapy individually; however it is often advised for couples to enter therapy together. By giving them a safe and confidential space, they may be able to come to a place of understanding.’

Ben Edwards recommends understanding each other’s reasons for a lack of sexual desire or drive, and to avoid blame or shame.

‘When working with my clients on their relationships, I encourage them to understand each other’s “why”,’ he states. ‘We all have our reasons for wanting certain things and you must communicate this to your partner.

‘Lack of communication could be detrimental and to your partners own self-esteem. When it comes to abstaining from sex, the last thing you want is for a partner to harbour feelings of rejection because of an emotional barrier.’

It’s crucial to have a safe space where both parties feel comfortable talking about difficult issues.

‘Doing this work with couples is about opening up a safe space and the hopes and fears to do with sex to be discussed,’ explains Kate. ‘It’s important to see what has been tried and not tried and the ways that couples express intimacy.

‘Integrating touch slowly and becoming more comfortable with each other in states of undress is also a gradual process.

‘I aim to help couples understand desire and arousal so that we can try and get them to a place where they can meet sexually.’

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